Bipolar disorder, is a psychiatric diagnosis defined in the DSM-IV-TR. It is a disorder characterized by periods of extreme, often inappropriate, and sometimes unpredictable mood states. In the past this disorder was called manic-depression. The term "manic-depression" was coined to describe the high emotional states of mania and depression that were experienced.

Bipolar individuals generally experience mania, hypomania or mixed states alternating with clinical depression and euthymic or normal range of mood over varied periods of time. There are many variations of this disorder. A person with bipolar disorder generally tends to experience more extreme states of mood than other people. Moods can change quickly (many times a day) or last for months. Bipolar individuals tend to have very 'black and white' thinking, where everything in life is either a positive aspect or a negative. Mood patterns of this nature are associated with distress and disruption, and a relatively high risk of suicide. Bipolar disorder is also associated with a variety of cognitive deficits, in particular, difficulty in organizing and planning. The disorder may also skew the ability to judge others' emotion, and alter sense of awareness. Bipolar individuals can be overly observant and analytical of their environment, and in some cases paranoid of others. [1]

Bipolar disorder is usually treated with medications that help to stabilize mood, and/or therapy and counselling.

Some studies have suggested that while bipolar disorder alters emotion, there may be a correlation between creativity and bipolar disorder, although it is unclear what the relationship is between the two. [2][3][4]

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Bipolar disorder is commonly categorised as either Bipolar Type I, where an individual experiences full-blown mania, or Bipolar Type II, in which the hypomanic "highs" do not go to the extremes of mania. The latter is much more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing depression. Psychosis can occur, particularly in manic periods. There are also 'rapid cycling' subtypes. Because there is so much variation in the severity and nature of mood-related problems, the concept of a bipolar spectrum is often employed, which includes cyclothymia. There is no consensus as to how many 'types' of bipolar disorder exist (Akiskal and Benazzi, 2006). Many people with bipolar disorder experience severe anxiety and are very irritable (to the point of rage) when in a manic state, while others are euphoric and grandiose.

People having a manic episode of mood can be elated, euphoric, irritated and/or suspicious. There will be an increase in physical and mental rate and quality. Increased energy and over-activity is common; speech can become racing. The need for sleep is reduced. Attention span is low and easily distracted. Unrealistic, grandiose or over optimistic ideas may be voiced or attempted. Social skills are impaired, and impractical ideas may lead to financial and relationship indiscretions.

Hypomania is generally a less destructive state than mania, and people in the hypomanic phase generally experience less of the symptoms of mania than those in a full-blown manic episode. The duration is usually also shorter than in mania. This is often a very 'artistic' state of the disorder, where there is a flight of ideas, extremely clever thinking, and an increase in energy.

Mixed episodes can be the most volatile of the bipolar states, as moods can easily and quickly be triggered or shifted. Suicide attempts, substance abuse, and self-mutilation may occur during this state.

Rapid cycling, defined as having four or more episodes per year, is found in a significant fraction of patients with bipolar disorder. It has been associated with greater disability or a worse prognosis, due to the confusing changeability and difficulty in establishing a stable state. Rapid cycling can be induced or made worse by antidepressants.[7]

Numerous studies show that bipolar disorder involves certain cognitive deficits or impairments, even in states of remission.[8] Deborah Yurgelun-Todd of McLean Hospital in Belmont, Massachusetts has argued these deficits should be included as a core feature of bipolar disorder. According to McIntyre et al. (2006), "study results now press the point that neurocognitive deficits are a primary feature of BD; they are highly prevalent and persist in the absence of overt symptomatology. Although disparate neurocognitive abnormalities have been reported, disturbances in attention, visual memory, and executive function are most consistently reported."[9]

A number of recent studies have observed a correlation between creativity and bipolar disorder,[2][3][4] although it is unclear in which direction the cause lies, or whether both conditions are caused by some third, unknown, factor.
It has been hypothesized that temperament may be one such factor.

Children with bipolar disorder may not meet the DSM-IV definition. In pediatric cases, the cycling can occur very quickly (see section above on rapid cycling).Cite error: Invalid <ref> tag. Tag has more than one name associated with reference.

Children with bipolar disorder tend to have rapid-cycling or mixed-cycling [10]. Rapid cycling occurs when the cycles between depression and mania occur quickly, sometimes within the same day or the same hour. When the symptoms of both mania and depression occur simultaneously, mixed cycling occurs.

Often other psychiatric conditions are diagnosed in bipolar children. These other diagnoses may be concurrent problems, or they may be misdiagnosed as bipolar disorder. Depression, ADHD, ODD, schizophrenia, and Tourette syndrome are common comorbid conditions. Furthermore some children with histories of abuse or neglect may have Bipolar I Disorder. There is a high comorbidity between Reactive attachment disorder and Bipolar I Disorder with about 50% of children in the Child Welfare System who have Reactive Attachment Disorder also have Bipolar I Disorder[11]

Misdiagnosis can lead to incorrect medication.

On September, 2007, experts (from New York, Maryland and Madrid) found that the number of Americanchildren and adolescents treated for bipolar disorder increased 40-fold from 1994 to 2003, and it was increasing ever since. However, the increase was due to the fact that doctors more aggressively applied the diagnosis to children, and not that the incidence of the disorder had increased. The study calculated the number of visits which increased, from 20,000 in 1994 to 800,000 in 2003, or 1% of the population under age 20. [12]

People with a diagnosis of bipolar disorder are at higher risk of suicide. It is estimated that 10 to 15 per cent of people admitted to hospital with the diagnosis will eventually die by suicide. {cn}

Although many people with bipolar disorder who attempt suicide never actually complete it, the annual average suicide rate in males and females with diagnosed bipolar disorder (0.4%) is 10 to more than 20 times that in the general population[13]

Individuals with bipolar disorder tend to become suicidal, especially during mixed states such as dysphoricmania and agitated depression. Persons suffering from Bipolar II have high rates of suicide compared to persons suffering from other mental illnesses, including Major Depression. Major Depressive episodes are part of the Bipolar II experience, and some have speculated that sufferers of this disorder spend much of their life in the depressive phase of the illness.

According to Psychology Today[14], the divorce rate for
couples where at least one spouse is bipolar is 90%. For comparison purposes, the general divorce rate is commonly held to be about half as much (around 50%), implying that this illness causes substantial additional burdens on married life.

Flux is the fundamental nature of bipolar disorder. Both within and between individuals with the illness, energy, mood, thought, sleep, and activity are among the continually changing biological markers of the disorder. The diagnosticsubtypes of bipolar disorder are thus static descriptions—snapshots, perhaps—of an illness in continual change, with a great diversity of symptoms and varying degrees of severity. Individuals may stay in one subtype, or change into another, over the course of their illness. The DSM V, to be published in 2011, will likely include further and more accurate sub-typing (Akiskal and Ghaemi, 2006).

For a diagnosis of Bipolar I disorder according to the DSM-IV-TR, there requires one or more manic or mixed episodes. A depressive episode is not required for the diagnosis of Bipolar I disorder but it frequently occurs.

Bipolar II, which occurs more frequently is usually characterized by at least one episode of hypomania and at least one depression.

A diagnosis of Cyclothymic Disorder requires the presence of numerous hypomanic episodes, intermingled with depressive episodes that do not meet full criteria for major depressive episodes. The main idea here is that there is a low-grade cycling of mood which appears to the observer as a personality trait, but interferes with functioning.

If an individual clearly seems to be suffering from some type of bipolar disorder but does not meet the criteria for one of the subtypes above, he or she receives a diagnosis of Bipolar Disorder NOS (Not Otherwise Specified).

Although a patient will most likely be depressed when they first seek help, it is very important to find out from the patient or the patient's family or friends if a manic or hypomaniac episode has ever been present, using careful questioning. This will prevent misdiagnosis of Depressive Disorder and avoids the use of an antidepressant which may trigger a "switch" to hypomania or mania or induce rapid cycling. Recent screening tools such as the Hypomanic Check List Questionnaire (HCL-32) have been developed to assist the quite often difficult detection of Bipolar II disorders.

Researchers are using advanced brain imaging techniques to examine brain function and structure in people with bipolar disorder, particularly using the functional MRI and positron emission tomography. An important area of neuroimaging research focuses on identifying and characterizing networks of interconnected nerve cells in the brain, interactions among which form the basis for normal and abnormal behaviors. Researchers hypothesize that abnormalities in the structure and/or function of certain brain circuits could underlie bipolar and other mood disorders, and studies have found anatomical differences in areas such as the prefrontal cortex[15] and hippocampus.

Better understanding of the neural circuits involved in regulating mood states, and genetic factors such as the cadherin gene FAT linked to bipolar disorder,[16] may influence the development of new and better treatments, and may ultimately aid in early diagnosis and even a cure

NIMH has initiated a large-scale study at 20 sites across the United States to determine the most effective treatment strategies for people with bipolar disorder. This study, the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), will follow patients and document their treatment outcome for 5-8 years. For more information, visit the Clinical Trials page of the NIMH Web site.[19]

"Mortality studies have documented an increase in all-cause mortality in patients with BD. A newly established and rapidly growing database indicates that mortality due to chronic medical disorders (eg, cardiovascular disease) is the single largest cause of premature and excess deaths in BD. The standardized mortality ratio from suicide in BD is estimated to be approximately 18 to 25, further emphasizing the lethality of the disorder.".[20]

Kraepelin, Emil. 1921. Manic-depressive Insanity and ParanoiaISBN 0-405-07441-7 (English translation of the original German from the earlier eighth edition of Kraepelin's textbook - now outdated, but a work of major historical importance).

Carta, M.G. & Angst, J. (2005). Epidemiological and clinical aspects of bipolar disorders:Controversies or a common need to redefine the aims and methodological aspects of surveys. Clinical Practice and Epidemiology in Mental Health, 1(4).

Seal, K., Mansell, W. & Mannion, H. (2008). What lies between hypomania and bipolar disorder? A qualitative analysis of twelve non-treatment-seeking people with a history of hypomanic experiences and no history of major depression. Psychology and